Home of the Nouveau-Bese

Creeper Bait —

Trigger warning: This post is all about the Medifast very low calorie diet and the science behind its efficacy.

Sometimes I wish I were thin.

I don’t know why, exactly. I just fantasize about having washboard abs and long, flowing Fabio hair. But those are just my superficial ambitions. Until recently, I couldn’t quite put my finger on the underlying motivation for my weight loss fantasies.

Then, I saw this commercial and it all came bubbling to the surface:

This brief Medifast commercial made me realize that I really want to lose 130 pounds so that when I come home from a fantastic vacation, I might get the ol’ up and down gaze from a creepy, old customs agent.

And, of course, the woman in the commercial is clearly loving it, as she grins demurely.

The message, of course, is that the customs agent nearly didn’t let her back into the country because she looks so different from her troll-like passport photo.

“Gaaaaah! Is it even human!?! And yet, here stands a fair maiden claiming the passport of a monster. Do I believe this beauty or my own eyes?”

“Of course!” He realizes. “She’s undergone a magical transformation thanks to the potion of some wise and powerful wizard. I shall allow her safe passage.”

And the scene fades to this screen…

… and we hear Customs McCreepy say, “Welcome home.”

I have to admit that the “didn’t recognize your passport” storyline is rather clever for weight loss advertising. And the imagery is impressive… she’s coming back from a trip abroad to who knows where with a light flowery dress on and sunglasses on her head. It’s effective and powerful.

The commercial launched in January as Medifast’s first ad campaign, and featured an actual client of the program, Jessica Westmoreland. Westmoreland’s 85-pound weight loss is featured in Medifast’s “Success Stories,” which includes the obligatory B&A pic:

Hey, the before picture… it seems familiar. It’s so small though.

I can make it bigger, but I can’t enhance it because I don’t know how.

Hey, that’s the picture from the passport.

At first I thought they Photoshopped horizontal stripes on her, but it’s a stamp of some sort. However, it does appear that the passport photo has been chunkified. Her face, shoulders and chest seem broader.

So, I tried to align the photos based on her facial features and neckline, and this is what I came up with, since I’m clearly in the mood to make animated gifs.

They Photoshopped out the beeper and the logo. Magazines Photoshop women to make them look thinner. So, why not Photoshop a passport photo in a weight loss commercial to make her look even blockier and more horrid?

The subheader that stands out above the before and after picture is a quotes from Westmoreland which reads, “My relationships have changed in a positive way because I am happier, more confident, and — for once — feel deserving of love and friendship.”

These may be Jessica Westmoreland’s words and experience, but the disgusting thing is that Medifast chose to highlight this particular feeling.

“Deserving of love and friendship”? Because you lost 85 pounds? No, I’m sorry, but there is no weight range for love and friendship. If Westmoreland felt as though she did not deserve love and friendship when she was fat, then there was something wrong with her mind, not with her body.

But for Westmoreland, being fat kept her from a lot of things:

When I was 218 lbs, I ached all over. I had difficulty breathing and was too bulky to do any of the activities that I wanted to enjoy, like mountain biking and yoga. I dreaded going out in public and covered up my entire body with oversized clothing, even though my obesity was very obvious.

I beg to differ, Ms. Westmoreland, but there are people WAAAAAAAAAAAAAAY heavier than 218 pounds who enjoy mountain biking and yoga. And there are plenty of fatshionistas out there rocking their bodies in beautiful fashions.

A cardiologist confirmed that I had inappropriate tachycardia as my rest heart rate was over 100 beats per minute. After she suggested that I seriously consider losing weight, I searched online and found only positive reviews of Medifast… At 133 lbs, my heart rate is normal, I’m not out of breath, my knees went from crunching and buckling when I walked to being pain-free, and I can touch my toes during yoga!

First of all, I can see how having a resting heart rate of 100 bpm would inspire you to do something, and since your doctor made the recommendation to lose weight, you would naturally follow through. But I’m curious… were you sedentary when you weighed 218 pounds? Because if you were, then exercise can help red

But I interrupted you. You were telling us all about how losing 85 pounds made life enjoyable once more:

My mental health and confidence has drastically improved. When I was overweight, I hid in my cubicle at my law firm. Now I’ve started my own law practice! My first marriage ended because of my weight, but I am now marrying a man who loves me regardless of my size!

No, your first marriage did not end because of your weight. It sounds like your marriage ended because your ex was an asshole. As you have pointed out, the man you love now loves you regardless of your size. Is it because you lost the weight that he wanted to marry you? Doesn’t sound like it. So, if you regain that 85 pounds and he stays with you, is it because of your weight? Nope. It’s because your second husband is not a superficial jackass.

Likewise, it was not your weight that prevented you from starting your own law practice, and losing weight did not “drastically improve” your mental health or confidence. What changed is that you are no longer on the receiving end of shame and stigma.

It is the shame and stigma that prevented you from enjoying mountain biking and yoga. It is the shame and stigma that made you hide in the cubicle at your law firm. It is shame and stigma that caused your first marriage to end. Whether your obesity was “very obvious” or not, let’s not confuse the cause (stigma) with the effects (self-loathing).

But, let’s set aside the psychological issues surrounding the testimonial. When we hear “welcome home,” we see that Medifast is “Proven, healthy weight loss.” But is it true? Is the best solution to weight stigma starvation on an 800-1,000 calorie diet. Is Medifast capable of helping other people like Westmoreland lose 85 pounds so they, too, can start living the life they always dreamed?

At the bottom of Westmoreland’s testimonial is the disclaimer, which reads, “Results not typical. You should not expect to experience these results. Typical weight loss on the Medifast 5 & 1 Plan is up to 2 to 5 lbs per week.”

According to Medifast, the “typical weight loss” after one year is anywhere between 104 and 260 pounds, making her 85 pound weight loss look like a walk in the park. And Westmoreland says, “I saw drastic results in the first 10 days; others commented on my loss, as well. It only took six months to shed 85 lbs!” That’s a loss of three pounds per week. So, by Medifast’s definition, her weight loss is “typical.”

But, if you’ve read my calories in/calories out manifesto, you’ve already seen the evidence Medifast offers to support this claim*. But none of these studies comes even close to suggesting a “typical weight loss” of 2 to 5 pounds per week.

However, there was one study that, if you squint your eyes and tilt your head, might suggest such a result:

One possible source may be Medifast’s 40 week randomized, controlled trial of an 800-1000 calorie diet (PDF). Half of the 90 subjects were assigned to Medifast, and just 28 out of 45 (62%) finished the 16-week active weight loss phase. They lost an average 30 pounds (±13 pounds), or 1.9 pounds per week, give or take 0.8 pounds.

Close enough.

By 40 weeks, subjects in that same study had regained 11 pounds, or a quarter pound per week.

So, the closest thing to the 2 pound per week claim is a study that only looked at the active weight loss phase. Medifast’s “long-term” research (all one year or less) suggests an average weight loss of 30 pounds per year, or half a pound per week. And yet, when you view all of Medifast’s “Success Stories,” an interesting trend emerges, which I have captured in animated GIF form (click to animate):

Of all the weight loss categories, the 100+ pound group has 11 testimonials, while the 30 pounds or less group has just one.

I began to wonder how Medifast could continue to present itself as providing clients a “typical weight loss” of 2 to 5 pounds per week and to present its most dramatic before and after photos as evidence of its efficacy and potency, yet not have a shred of evidence to back it up.

I presented myself as a potential client named Zap Rowsdower, and began speaking with Medifast consultant Bryn:

Zap: I am a man who weighs 265 pounds. I would like to lose 65 pounds. What will be my daily caloric limit on your plan? And how soon can I lose that weight?Bryn: The daily caloric limit is the same for everyone on the 5 & 1 Plan, regardless of the amount of weight they have to lose – 800 to 1000 calories per day, depending on your choices. On the 5 & 1 Plan, again depending on how your body responds, you can lose up to 2 to 5 pounds per week. Assuming the high limit on this, you could lose up to 20 pounds per month. So roughly three and a half to four months, again, assuming you are losing the high end at 5 pounds per week. Some folks lose more, some lose less.

Zap: May I ask what the long-term success rate of Medifast is? Say, two years or longer?Bryn: I do not have any statistics on that, unfortunately. We do have a maintenance program, however, to assist you with your long-term success.

Zap: Okay, what about retention rates after one year?Bryn: From the clinical studies document: “Results were better than those typically reported for obesity pharmacotherapy in both short- and long-term studies and also better than those reported for partial meal replacement programs. Program retention at one year was similar to that reported in many controlled drug trials and better than most commercial programs reported in the literature.”

A common trick of weight loss programs is to claim better efficacy without using specific numbers. So I responded by citing just one of the reports I documented. I then followed up:

Me: So if your own research says that the most dedicated and committed clients lose an average of 30 pounds, how can you promise that potential clients can lose between 2 and 5 pounds?Bryn: I am sorry, but I do not have any more information than is available in the documentMe: But as a representative of Medifast, you are told how to respond to questions of efficacy and timing, correct? So, I’m wondering if it’s more realistic for me to hear that I can lose 2 to 5 pounds per week or half a pound per week, based on Medifast’s own research.Bryn: Unfortunately, this is outside the scope of my ability – I am here to provide answers to general questions and yours are very specific. At this point, my Nutrition Support department and the research nutritionist there may be able to provide you with far better information than I can. I do know that we are not promising 2 to 5 pounds loss – we mention that you can lose up to 2 to 5 pounds per week. It is possible, but not necessarily typical. [emphasis mine]

Recall the disclaimer at the bottom of Westmoreland’s testimonial: “Results not typical. You should not expect to experience these results. Typical weight loss on the Medifast 5 & 1 Plan is up to 2 to 5 lbs per week.” [emphasis mine]

So, yes, Medifast is saying that losing 2 to 5 pounds per week is typical, not just possible.

Bryn provided me with the phone number for the Nutrition Support Team, which is better equipped for detailed questions such as these. So, I called and spoke with Meredith. I only have a handful of direct quotes because Medifast is located in Maryland where it is illegal to record a phone conversation without consent. But I did take copious notes.

When I asked Meredith about Medifast’s own research on the average weight loss of 30 pounds, her defense was that the studies don’t say how much weight the study subjects were trying to lose. So maybe, just maybe, they only had 30 pounds to lose.

Fair enough, then what is the 2 to 5 pounds claim based on?

She stammered a bit, then said, “It’s just based on I guess typical, consistent results that we typically have.”

I asked how those “typical, consistent results” they typically have are documented, and she said she would do some digging and “maybe give you an email” by the end of the day.

When asked how Medifast prevented their clients from going into conservation mode, whereby the body prevents caloric expenditure in a desperate bid to cling to its precious body fat stores. Her response was that conservation mode is triggered by exercise, and that if you “exercise a little more or almost at all,” then the will hang onto fat instead of burning it. Meredith also explained how during the first three weeks, Medifast recommends very light exercise, or none at all.

So how does Medifast prevented muscle wasting during rapid weight loss? Meredith claimed Medifast supplements contain enough protein to prevent wasting. Except, protein acts as a fuel source by the body… it’s not just magically transformed into muscle. During ketosis, the body begins breaking down both fat and muscle. Without adequate protein AND exercise, muscle wasting is inevitable.

Most low-carb diets have ridiculously low carbohydrate levels, but there are no caloric restrictions. So, a person could theoretically be on a low-carb diets AND eat enough protein AND get enough exercise to minimize muscle wasting. But on Medifast, unless they have some research that proves otherwise, muscle wasting, including the muscle that is the heart, should be of major concern.

I asked Meredith about the failure rates of low-carb diets and how Medifast could make claims of efficacy when even low-carb diets can’t make such claims. “I’ll have to get back to you.” What about the fact that using protein for energy produces BUNs, or an excess of nitrogen in the blood. “I will need to get back to you.” In the end, most of my questions required a follow-up and Meredith offered to have someone with a better understanding of the issues call me, so I gave her my cell number.

That was Monday. I called back today and Meredith transferred me to a dietitian named Jennifer, who said the 2 to 5 pound claim is in their research. “I’d have to go through all the studies to pick it out,” she said. I responded that I read all the research and didn’t see anything except the study that found a 1.9 pound average after 16 weeks of the active weight loss phase. She said that she would have to contact their researchers for the answer, then asked, “What do you need this information for?”

Well, theoretically, I’m a client who is skeptical about Medifast’s “proven, healthy weight loss.” Given the prominence of the claim, you would think the answer could be given without questioning the intentions of the inquirer. But she asked for my email and said she would consult their researchers. We shall see if she follows through.

But according to both of the Medifast representatives I spoke with, clients don’t ask questions like this. Meredith laughed, “We usually get ‘Can we have cucumbers on your plan?'” But these are the kinds of questions that matter when a person is contemplating a very low calorie diet, like Medifast.

So perhaps I wasn’t a typical Medifast client, but neither is Jessica Westmoreland. The fact is, Westmoreland isn’t lifelong fatty. According to Westmoreland’s MySpace profile, it wasn’t long ago that Westmoreland described herself as “athletic.”

And in a photo album that was created on May 22, 2009, there’s just one photo:

So between 2009 and 2012, Westmoreland went from being relatively slender and athletic to fat and back to slender again on Medifast.

This is exactly like the claims made by Drew Manning, the personal trainer who gained 70 pounds in one year, then lost it all again just to prove he could. The fact is, gaining and losing weight within a brief period of time is not as difficult as it is for people whose bodies have been consistently fat for years, or decades.

To understand why, you have to look at the research of Ethan Sims, as outlined in Gina Kolata’s Rethinking Thin. Like the Ancel Keys starvation experiments, Sims had average-sized prisoners overeat to gain weight, but as soon as the overfeeding ended, their weight returned easily to baseline.

Likewise, Westmoreland’s weight may have been unnaturally high because of her increased sedentary lifestyle and perhaps a change in eating habits. But that doesn’t mean that Westmoreland has the kind of genetic predispositions that makes losing weight more difficult.

Whatever, the case, there is zero evidence that Medifast clients “typically” lose between 2 to 5 pounds per week. Westmoreland is a statistical outlier, both in regards to her success on Medifast and to her apparent pleasure at being eye-groped by creepers in Customs.

Medifast’s Research PDF provides the outcomes of nine studies, four of which follow subjects for at least one year. Medifast puts a glossy spin on its research summaries, but the actual results in the research aren’t nearly as impressive as those presented on media resources page (proceed to the end of this blog post to check out the spin provided in each study):

Study 2 — A randomized controlled trial of 119 type 2 diabetics seeking weight loss were assigned to one of two 25% caloric restriction diets, one of which was the Medifast Plus for Diabetics program. Seven subjects dropped out before the start of the program, while just 48 completed the 34-week active weight loss phase. Of the original 54 Medifast subjects, the 31 who remained lost an average of 16 pounds, or half a pound per week. At week 60, 23 Medifast patients lost an average of 11 pounds, or one-fifth of a pound per week. At week 86, 16 Medifast patients lost an average of 12 pounds, or one-tenth of a pound per week. This also means that the average patient who started at 224 pounds spent 86 weeks on the Medifast plan for a final weight of 212 pounds.

Study 3 — An evaluation of Medifast’s medical charts for 1,351 healthy patients (out of 9,948 available records) who were on the Medifast program for at least 12 weeks. Patients averaged between 650-850 calories per day, and some were prescribed 30 mg of Phentermine, an appetite suppressant medication (ASM), for the active weight loss phase. If their hunger persisted, they doubled the dose. If subjects needed a longer-lasting effect, they were prescribed Phendimetrazine. Just 324 (25%) patients lasted 52 weeks, and of those patients, the ones who reported being consistent in using the Medifast supplements and ASMs lost an average of 29 pounds, while those who were not prescribed an ASM lost 30 pounds, or just over half a pound per week.

Study 5 — A randomized controlled trial of 80 overweight kids aged 8 to 15 and 40 parents. After 6 months of a 500 calorie deficit, researchers followed them for an additional 12 months of weight maintenance. No actual weight loss data is provided, and since the study was presented at a conference, only the abstract is available. They do inform us that subjects began the program averaging the 99th percentile. Six months later subjects reached 96.6% and after the full 18 months they were at 96.4%, making the average subject still obese.

Study 9 — A study (PDF) of the effects of a specific obesity gene on the weight loss attempts of 24 obese post-menopausal women. These women completed an average of 13 months on a 1,200 calorie diet, using either a meal replacement supplement or usual care. The meal replacement group either used Medifast or another brand. The study does not indicate how many patients used Medifast, or what the outcomes for those patients were. The only weight loss information provided is stratified by the genetic marker. Patients with the marker lost 36 pounds and those without lost 31.

And there are also two six-month trials:

Study 6 — A six-month open label trial of 47 overweight or obese men and women, half of whom dropped out by six months. Those who remained lost an average 25 pounds, or a pound per week.

Study 8 — An evaluation of a six-month intervention involving 14 low-income pre-bariatric surgery patients on a 1,000-1,200 calorie diet. The 10 who remained after six months lost an average of 27 pounds, slightly above a pound per week.

Like this:

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These statistics are a little frightening, but I would agree that most people won’t ask the in depth questions you asked. They just want to know if they will be deemed acceptable if they can complete the program. I’m so sick and tired of being seen as a “normal” human means you have to appear to be extremely thin and that even a woman who is 5’10 is still considered “fat” at 130 lbs. I once said to someone, “I just want to be treated like I’m normal” and they looked at me like I had spoken an alien language and then their response was an uncomfortable “They do, but…”. *sigh*….I’m even made to feel ashamed of just wanting to discuss the fact that take away the stigma of appearance (and I reiterate what I’ve said before, I think I’m gorgeous, it’s the rest of the world that is blind and that’s how I respond to the world), I’m just as acceptable as everyone else. I don’t know when it became “normal” to treat someone like a pariah because they aren’t skinny like a Nazi death camp prisoner. When did this happen? I remember a poster from the 70’s, showing an illustrated version of the perfect woman (I tried to find a graphic for it but I suck at googling things) and they showed a very buxom woman as a normal perfect woman, full bodied and gorgeous. Now to my way of thinking, that’s more normal than someone who looks starved or like a boy because she has no body fat and her breasts have gone flat and small and she has no discernable hips or butt. I know some people are like that naturally and I don’t judge them for it, but there are a lot of women striving to be that way that aren’t made that way. I just turn off the diet commercials now. They bore me!

Maybe they need to be asked these questions more. Perhaps we should start a call in campaign to ask where the proof is that Medifast makes people lose an average of 2 to 5 pounds per week. I’m going to call back again, definitely.

Diets are stupid and complicated. Health behavior is smart and simple. Ignore critics and focus on you. 🙂

I went on a diet under a bariatric doctor’s direction (he was anti-WLS). It was low-carb AND low-calorie. He had this machine that I’d stand on and I’d grip these handle-bar thingies and it’d spit out all kinds of information, but what he was really looking at was my muscle mass every few months. I did lose muscle mass over the course of the diet. I tried to stay on top of the 80-grams-of-required-protein-a-day, but I rarely made it that high. I just don’t like meat without potatoes or bread, I guess, and every other form of protein has carbs and even more calories attached to it (like nuts). I lost muscle mass also because I was so damn depressed all the time about not being able to eat what I wanted to eat (bad picky eater) OR how much I wanted to eat, that I sure as hell wasn’t going to torture myself with exercise.

Needless to say, it wasn’t a very good plan. I stuck with it (mostly) for about six months. I lost about 30 pounds, and I’ve since gained 15 of it back. It was nice to lose that weight, but I’m not sure it was worth it. Now I’m so obsessed with food and don’t trust myself, etc… that I think it did more harm than good overall.

Hey Rapunzel,
It does do more harm than good. Regardless of macronutrient composition, VLCDs and LCDs may make you lose some weight, but the low calorie nature of the diets will automatically trigger the adaptive thermogenesis that makes many people weight loss resistant. I wrote about it in this post, which is an excerpt from the book I’m currently writing on the subject. It’s long, but packed with information. Healthy is simple, and all weight loss diets inject needless complications because they make weight the goal, rather than improved health. They falsely believe that healthy behaviors result in thin bodies, and it is the thinness itself that indicates health. That’s just wrong. It’s our metabolic indicators, which, if we want to be healthier, we should strive to improve through lifestyle change. Whether that leads to weight loss or not doesn’t matter. Moving your blood pressure, cholesterol and blood sugars in the right direction is what matters. Good luck to you on your path to health!

Yeah, that’s what starvation will do. When I went on low carb diets in the past, I was so depressed and moody that no-one could stand to be around me. Combine this with the fact that I have a mood disorder anyway (bipolar) and this was really not a good scene.
In my human growth and development textbook, they mentioned a study wherein a group of men were put on a starvation diet. They became obsessed with food. It’s the body’s natural response to being deprived.

I’ve been seeing a commercial for Medifast lately (when DH is watching TV) that has a couple in it – they’re talking about how they went on Medifast together and lost something like 185 lbs between the two of them. Every time that commercial comes on, DH and I both say “Just give it some time, it’ll come back, and probably bring some friends with it.” (he’s heard me say that so many times to so many diet commercials that it’s become automatic for him to say it too).
I researched Medifast one time – they have a line of food that you have to buy in order to follow their die-t plan (and it’s not cheap). They talk about how tasty it is, but I’m betting it’s on the same order as the food from Jenny Craig/Nutrisystem/WeightWatchers (tasteless cardboard filled with chemicals, artificial flavors, and has to have nutrients added to it because everything has been processed out of it). Sorry, I’d rather spend that amount of money in the grocery store on real food, not have to worry about whether I’m going to be hungry after the meal is done, and not worry if I’ve lost any weight and is it going to come back and bring friends with it.

I think the FTC should make it a rule that if you want to use personal testimonials, then they have to show an After After picture from two years and five years after the diet ends. I know they could save a couple up, but it would certainly reduce their stockpile.

Fantastic article – and frightening. If people would just start applying common sense to their approaches to food and movement, we’d all be so much happier. Instead, we hope for miracles – that each of us will be the statistical outlier, we will be the 5% that keeps weight off for an extended period of time. Even though we know better, we put our faith in gimmicks, pills, devices…

How about we all just go for a nice, long walk, learn to be nicer to each other (and ourselves), and fuel our bodies with delicious, nutritious, real food?

“You should not expect to experience these results.” Ummm…o-kay. *Quizzical dog head tilt* So if I can’t get the same results as your SPOKESPERSON…why the hell would I even want to try your stupid diet?
They are basically saying “We’re lying to your face about how successful our system is – but we’re betting you are stupid and desperate enough to give us money anyway in the hopes you will magically win the metabolism lottery for no scientific reason. Come on Fatty McFatterson, you have to at least say you *tried* dieting to get a modicum of sympathy disguised as respect from society at large!”

Not only are there many studies that show diets don’t work – there are studies that show processed food is unhealthy for us. Commercial diet systems that shill prepackaged meals are waaaaay behind the times: not only are they ineffective but they fly in the face of the whole/raw/organic/etc. food trend that savy shoppers of all sizes are proponents of.
Psychologically, I think people are tricked into the “shake substitute” type of diet because it taps into the Super Supplement/GNC mindset where people try to optimize and streamline their nutrition by packing essential food elements into pill and powder form. But here’s the thing: all the diet commercials I see don’t say their diet is healthy – just that people who use it supposedly get “healthier” because of the (not typical) weight loss that accompanies the diet change. They have to make people think that the weight loss results are permanent, because the idea of staying on any diet system for the rest of your life in order to maintain weight loss is enough to make even the most desperate pudgy person run screaming into the night.

When I see diet commercials I don’t get mad at them – I get mad at the culture that made them possible. If people weren’t so desperate to jam their socially unacceptable bodies into an insanely small cultural mold, they would laugh the diet companies out of business. But we’re so desperate to fit in and not be stigmatized that we actually consider eating horrible tasting and unsatisfying food that is most likely chemically unhealthy for us, just so we *might* lose weight. And this is treated as normal, even laudatory behavior. The next person who proudly tells me they’re on a diet isn’t going to hear “good for you” – they’re going to hear “are you crazy?!?!”

In my adult life, I’ve been every size from 108 pounds to 310. And, at all sizes, creepy types still leer. Oddly, I don’t suddenly start enjoying this if I’m a smaller size.
I fantasize about being a socially acceptable size a lot more often than I care to admit. Thing is, I know that dieting will never get me there. In fact, dieting makes me fatter. Every single damn time. Which is a big reason why I refuse to do it any more.
I looked into Medifast at one point. Their so called food sounds absolutely awful.

I did Medifast at one point fairly meticulously. I did the full blown shakes only diet. 5 shakes a day, 90 calories each. I even went on vacation with a full complement of shakes and didn’t eat any food other than the shakes on the vacation and yes, that competely SUCKED!!

I didn’t really lose a substantial amount of weight during that time, about 30 lbs, which was about 10% of my weight, but over the length of time I did the shakes, that’s not very much and by the end I developed extremely severe psoriasis. Can I prove that the shakes led to the psoriasis? No, but they are soy based, and soy can trigger psoriasis. If you want to google how much 8 shots of Enbrel are a month, not mention the various topicals, you can and you can bet your sweet patootie that’s a boatload more than any fat related disease I may or may not have developed, would ever cost the health care system. Oh and I always weigh significantly more than I when I started Medifast. I have to keep telling myself, never again, never again.